Risk groups and their relatives - advice and information
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Advice and information about COVID-19 for risk groups and their relatives.
The general infection control advice, such as staying home when you are ill and having good cough etiquette and hand hygiene, still applies to protect against infection from respiratory tract infections including COVID-19, see:
In addition, the risk of respiratory tract infections will be reduced by avoiding crowds and avoiding contact with people with respiratory tract diseases, especially when there is widespread transmission in society.
Most people who become infected with coronavirus (SARS-CoV-2) will experience mild respiratory tract symptoms that pass. Some groups are at particular risk of developing a more severe disease course (resulting in hospital admission, intensive care or even death), but even the majority of people in risk groups will experience mild symptoms.
The risk of a severe COVID-19 disease course rises with age and underlying medical conditions, with men being at greater risk than women.
Vaccine against COVID-19
The purpose of vaccination against COVID-19 is to prevent disease or to make the course of the disease milder. Everyone who is recommended to take the COVID-19 vaccine are encouraged to take it.
Vaccination and having had COVID-19 provide relatively good protection against a severe disease course. Vaccinated people in risk groups can therefore generally live more like everyone else by following the general infection control advice.
However, vaccination is no guarantee against reinfection with the COVID-19 virus or transmitting it to others.
Protection against infection may diminish over time. The NIPH recommends that the following groups should take a new booster dose (for most adults this will be dose no. 4) with coronavirus vaccine before the coming winter season:
- People in the age group 65 years and older
- People in the 18-64 age group with an underlying risk of a severe disease course
- Young people in the age group 12-17 years with a serious underlying condition
- Pregnant women in the 2nd and 3rd trimester
Healthy people under the age of 65 may have the corona vaccine if they wish to do so.
Contact with others
People in risk groups must assess the risk of infection against the need of contact with others, and decide which measures are suitable to visit family and friends, based on one's own risk of a severe disease course from respiratory tract infections, how widespread local transmission is, their contact patterns, recent COVID-19 disease, their vaccination status and whether they have newly arisen respiratory tract infections.
Choosing a small group of people to interact with regularly will reduce the risk of transmission.
In times of widespread transmission in society, people in risk groups can use face masks where they cannot maintain a distance.
People with newly arisen symptoms of a cold or respiratory tract infection are recommended to use face masks if they need to care for or visit people in risk groups.
Risk groups for a severe COVID-19 disease course
Risk assessment applies at a group level, not to the individual. There will be considerable individual variations within each risk group. If necessary, speak to your doctor about your risk of a severe COVID-19 disease course.
Younger people are at a low risk of a severe COVID-19 disease course, but those with poorly managed diseases/conditions, or combinations of several underlying conditions, may be at greater risk.
The following people are recommended to consider shielding themselves in periods of widespread transmission in society, by for example limiting the number of close contacts. The risk varies within the groups, and as a general rule the risk increases with age and the number of underlying risk conditions:
- People in risk groups who have not followed current vaccine recommendations.
- People (regardless of vaccination status) with:
- diagnosed severe and moderate immunodeficiency
- organ transplantation
- haematological cancer in the past five years
- other active cancer, ongoing or recently completed anti-cancer treatment (especially immunosuppressive treatment, radiotherapy to the lungs or chemotherapy
- severe kidney failure (stage 5) or on active dialysis and patients who are considered by their attending physician to have a severely weakened immune system and who do not belong to one of the above groups.
Further information about risk groups
NIPH’s assessments may change as more knowledge becomes available. Here is an overview of the main risk factors. This assessment applies to people aged over 18 years.
The risk of developing severe COVID-19 illness rises significantly with age, and age appears to be the dominant risk factor regarding the development of severe illness and death. With advanced age, the incidence of chronic diseases also increases. It may be difficult to distinguish the risk caused by age from the risk caused by disease, but analyses that adjust for several risk factors show that age is an independent risk factor.
A person's risk should not be based solely on age, but also on an individual assessment of their general health.
Several studies show that people who have undergone organ transplantation have a significantly increased risk of a severe COVID-19 disease course. People on the waiting list for organ transplantation should preferably be vaccinated before transplantation. Organ transplantation shall not be postponed due to vaccination.
This group includes people with severe congenital or acquired immune deficiency conditions that can lead to significant immune deficiency and leads to high risk for severe COVID-19 disease course. The conditions include severe combined immunodeficiency, immunodeficiency associated with major defects (e.g., Wiskott-Aldrich syndrome), common variable immunodeficiency, immunodeficiency with predominant antibody deficiency (e.g., hypogammaglobulinemia) and some other types of severe immunodeficiency conditions. The group also includes HIV patients with low CD4 counts who should be considered for vaccination by their doctor.
People with sickle cell anemia also have an increased risk of a severe disease course.
People with active cancer, ongoing or recently discontinued treatment for cancer (especially immunosuppressive therapy, radiation therapy for the lungs or chemotherapy) have an increased risk of a severe COVID-19 disease course. Active cancer is defined as a cancer that has not been radically treated and assumed to be cured. Recently completed cancer treatment is defined as completed within the last 6 months.
When planning the start of cancer treatment, it should be considered whether patients can be vaccinated before starting. Vaccination should not delay the start of treatment. A large study from England indicates that people with blood cancer have a particularly high risk in the first five years after the diagnosis is made.
Neurological diseases or muscle diseases that cause impaired coughing or lung function
In this group we find people with cerebral palsy (CP), mental retardation, severe muscle diseases, spina bifida, as well as diseases that affect the brain in adults and the elderly (e.g., Parkinson's and ALS). In general for these diseases, people may have physical immobility (e.g., use a wheelchair) and / or reduced lung function and coughing power, risk of food or drink entering the respiratory tract, or they have a genetic condition that increases morbidity.
The risk of a severe disease course in people with CP depends on how severe their CP is, see text above. Milder degrees of CP will not pose any risk in themselves.
Several studies show that adults with Down's syndrome have a higher risk of a severe COVID-19 disease course. The risk increases with age. Down's syndrome can lead to an increased incidence of autoimmune diseases, diabetes, low metabolism, obesity, dementia and congenital heart disease.
Furthermore, people with Down's syndrome may have inappropriate immune responses in COVID-19, which further increases the risk of a severe course. All people with Down's syndrome who are 16 years and older are therefore given priority for vaccination.
Chronic kidney disease
Chronic kidney disease increases the risk of a severe COVID-19 disease course when you adjust for age and other risk factors. This is especially true for people with significantly impaired renal function. People with moderate / severe kidney failure are considered to have a significantly increased risk.
Chronic liver disease
Chronic liver disease also carries an increased risk, especially with significantly impaired liver function.
Immunosuppressive therapy in autoimmune diseases
Patients using immunosuppressive drugs may have an increased risk of severe disease course. It is probably the drugs themselves, and not the underlying disease, that increase the risk. Immunosuppressive drugs include TNF-alpha inhibitors, interleukin inhibitors, methotrexate, and more (see Felleskatalog). These drugs are used, among other things, for multiple sclerosis (MS), inflammatory joint diseases and inflammatory bowel diseases.
Diabetes has been reported as one of the most common underlying diseases in patients with a severe disease course. In studies that have been adjusted for age and other risk factors, patients with diabetes have a higher risk of severe COVID-19.
The duration of the diabetes disease and the incidence of late diabetic complications seem to increase the risk. Poor blood sugar control is a risk factor for a severe course, but diabetic patients with well-regulated blood sugar levels are also recommended to be vaccinated. All people with diabetes who are 18 years and older are therefore given priority for vaccination.
Chronic lung disease
People with chronic lung disease have increased risk of a severe COVID-19 disease course. This group includes people with severe asthma, who have used high-dose inhaled steroids or steroid tablets during the past year.
People with obesity have an increased risk of a severe disease course, and the risk increases with increasing body mass index (BMI).
Cardiovascular diseases include a range of diseases that may increase the risk of a severe COVID-19 disease course. There is evidence to suggest that the risk increases with the severity of the underlying disease. In studies that adjust for age and other risk conditions, high blood pressure does not appear to be an independent risk factor for hospitalisation or death from COVID-19.
Other chronic diseases
A number of studies suggest that dementia and stroke are independent risk factors for a severe COVID-19 disease course
Nursing home residents
Residents of nursing homes are considered to be at greater risk of a severe COVID-19 disease course, based on a combination of advanced age, frailty, multiple chronic diseases, impaired functions and low activity level.
Children and adolescents
The risk of serious COVID-19 disease course among children and adolescents is generally very low. This includes children and adolescents with serious and chronic illnesses or conditions, even though this group have a somewhat higher risk of hospital admissions. The total number of children with serious underlying illnesses who are admitted to hospital with COVID-19, is still very low and they have good prognosis.
Together with Norwegian Society of Pediatricians (Norsk Barnelegeforening) the NIPH recommend most children and adolescents with chronic illnesses and conditions to attend kindergarten and school as normal. It is very rare that siblings of children with rare underlying illnesses should be kept home from school and social arenas.
However, for some children with a serious illness, based on a general recommendation on protection against infectious illnesses, there will be a need to arrange adapted teaching and activity after assessment by the responsible paediatrician.
All children over 6 months of age with serious underlying diseases will now be offered vaccination. The vaccines are effective in order to protect against a severe COVID-19 disease course, and even only one dose offers good protection.
Pregnant and breastfeeding women
Most pregnant women will get a mild disease course. Pregnant women with COVID-19 who develop symptoms still have a slightly higher risk of needing treatment in hospital, intensive care unit and with a respirator compared with non-pregnant women with COVID-19 of the same age.
The risk of severe progression increases if the pregnant woman has underlying diseases such as diabetes, cardiovascular disease and / or obesity. The risk for pregnant women increases with the length of pregnancy when they are infected. The NIPH therefore recommends that pregnant women should be vaccinated, read more here:
People with impaired immune systems
Patients with severely impaired immune systems should, even after vaccination with booster doses, be aware that they may have lower protection than people with normal immune function and should therefore consider to live more sheltered when there is widespread transmission in society. In addition, it is important that close contacts in the same household are vaccinated.
Together with medical experts and the specialist health service, NIPH has prepared an overview of the diseases for, and medications used by, people who are recommended to have three doses, and at least two booster doses (as per December 2022). People with severely compromised immune systems can be considered for more booster doses by the doctor who knows their situation best.
For vaccination of people with underlying conditions, see:
Employees in risk groups who are not vaccinated or have not had COVID-19
The Norwegian Directorate of Health has prepared its own recommendations for employers in the health sector.
Should people in risk groups change ongoing treatment?
No. There is no reason to advise against starting or stopping ongoing immunosuppressant treatment. If people who use immunosuppressants become ill, they should contact their doctor for advice about medication, testing and examination.
What should you do if you become ill?
- Newly-arisen respiratory tract symptoms, COVID-19 testing and positive test results
- About coronavirus testing
For some groups with a particularly high risk of developing a severe disease course, drug treatment may be appropriate (hdir.no)
If you develop other acute symptoms that you would normally seek medical attention for, contact the healthcare service - your own doctor, or the out-of-hours medical service (116 117). With severe symptoms ring 113.
The advice about vaccination is updated regularly:
- Who can receive the coronavirus vaccine?
- Coronavirus vaccine– information for the general population
The Norwegian Institute of Public Health recommends that people in risk groups receive an influenza vaccine every year and a pneumococcal vaccine (against pneumonia) every ten years. These vaccines will not prevent infection with SARS-CoV-2.
Our advisory service is primarily intended for Norwegian government agencies, the healthcare service and municipalities, so we do not have the capacity to reply individually to members of the public.